Health leaders to Congress: RACs inappropriately denying payments

Hospital and health system leaders briefed congressional staff Friday on the problems they face due to inappropriate payment denials by Medicare recovery audit contractors, AHA News reported. Steven Hanks, M.D., executive vice president and chief medical officer at The Hospital of Central Connecticut, said that despite medical need, too often RACs deny payment for inpatients on the grounds that the services should have been provided in the outpatient setting. Hospitals have appealed 96% of the denials and successfully overturned 94% of them, Hanks said. While he agreed that RACs should go after hospitals and health systems that are involved with fraudulent and abusive practices, Hanks said they should not indiscriminately deny claims. Article

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